Where Obamacare Goes Wrong

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The Obama Administration is counting down the days and rounding up “navigators” to get Obamacare off the ground. (Those navigators, by the way, will get $58 for each person they sign up, on top of their hourly pay.) The big question: Is Obamacare going to work? Will it deliver better health to Americans? There are a lot of skeptics, including Forbes’ Paul Howard. Howard’s concern is that Obamacare is using mid-20th century assumptions about health and insurance in a 21st century world.

Washington’s view of health care remains deeply entrenched in mid-century assumptions about health and illness. Health care via industrial policy makes sense if illness is an Act of God to which all are equally vulnerable and a known quantity of health care can be delivered to everyone at a fixed price. If these assumptions are true, the largest payer – the government – can set the rules of the road, from which all (or almost all) benefit.

That was a reasonable picture of medicine well into the 20th century…when infectious diseases dominated U.S. deaths. But by 1950, heart disease and cancer had displaced infections as the nation’s most potent killers. (“Diseases of early infancy” was still the fourth-leading cause of death in 1950. By 2010, they had dropped off the table entirely.)

Howard points out something we all know: Governments do really well with big plans and projects. Think “highways” and “armies.” But when faced with things that require highly individualized knowledge and treatments (such as “heart attack” vs. “arrhythmia”), governments are not all that helpful. People are. And those people are health care professionals…and us. That’s right: WE are pretty darn good at taking care of ourselves. We have lots of tools that make our own health care accountability easier than ever: scales that tell us our BMI, iPad apps and walk-in health care clinics at Walmart.

If you look around, the people who will be developing the future of customized health solutions are likely app developers and consumer-savvy companies like FitBit and Nike who are already invested in the quantified-self movement. And as wearable, or swallowable, diagnostics get smarter, cheaper, and more powerful, health care will continue to accelerate away from hospitals and doctor’s offices and into your living room…

And this, Howard says, is where Obamacare goes off the rails:

This is where Obamacare goes most wrong – throwing hundreds of billions of dollars in new subsidies at the insurance market while also pushing insurance into categories called “bronze, silver, gold, and platinum” – with the powerful implication that the more we spend on premiums for broad and expansive insurance, the better the health care we’ll have.

Health care is complicated, but most of us are smart, want to be healthy and can partner with our health care professionals. We know what ails us most of the time. Obamacare is built on the notion that we can be regulated into better health – that more laws and standardizations will create for better care, when in fact the opposite is true. Louis Goodman and Tim Norbeck say,

There is indeed a proven solution to the problems of complexity, rising costs and shrinking access. It’s called competition, but the ACA [Affordable Health Care Act] doesn’t seem to have any provision for it in its 2,000 pages of government mandates. As Herbert Hoover noted, “Competition is not only the basis of protection to the consumer, but it is also the incentive to progress.”

Human beings – and their health care – can’t be quantified in one big government flow chart. What works for one person (diet, exercise and a glass of wine in the evening) may not work for another (who needs medication); Obamacare is going to move Americans from first class health care to “a work in progress.” That’s not healthy.